Physician response to written feedback on a medication discrepancy found with their elderly ambulatory patients

OBJECTIVE: To assess physicians' responses to written feedback on medication discrepancies found with their elderly ambulatory patients. DESIGN: Cross-sectional survey. SETTING: Four clinics of a large university-affiliated, multispecialty group practice associated with a 186,000-member health maintenance organization. PARTICIPANTS: Patients aged 65 and older (n=202) and their family physicians (n=32). MEASUREMENTS: Medication discrepancies and physicians' responses to written feedback on letters and adhesive labels containing a list of patients' actual medications. RESULTS: A medication discrepancy was identified with 171 of 202 patients (84.7%). They resulted from patients not taking charted medications (52.9%), patients taking medications that were not charted (34.3%), or difference in dosage and/or schedule (12.8%). The medications involved were mostly complementary/alternative (28.3%), respiratory/allergy (15.1%), and analgesics (14.1%). The majority of physicians reported that the letters (93.8%) and accompanying labels (90.6%) were helpful to them. Half of the physicians reported filing the letters in patients' charts, whereas the other half discarded them. The majority (93.8%) also perceived the labels as an additional benefit to their practice and placed them in patients' charts to be used to correct patients' medications. Receptivity to the feedback was unrelated to physician age group, sex, years in practice, or clinic of practice. CONCLUSION: Although medication discrepancies are common in elderly ambulatory patients, their family physicians appreciate assistance in correcting these discrepancies, although potential problems, such as cultural or organizational resistance to the open disclosure of medication discrepancies in medical records due to associated legal ramifications, may need to be resolved.